Study: Avoid Risk Factors to Prevent Aspergillosis in Patients With Severe Influenza

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All respiratory culture data—including sputum, endotrachial, and bronchial specimens—and bacterial and fungal pathogens were recorded.
All respiratory culture data—including sputum, endotrachial, and bronchial specimens—and bacterial and fungal pathogens were recorded.

Judiciously using antibiotics and avoiding risk factors are key to reducing cases of invasive aspergillosis in immunocompetent patients with influenza infection, according to research published in Open Forum Infectious Diseases.

Nancy F. Crum-Cianflone, MD, Infectious Diseases, Scripps Mercy Hospital San Diego, Naval Medical Center San Diego, conducted a case-control study among patients presenting with severe influenza requiring intensive care unit (ICU) admission, documented during the 2015-2016 influenza season. All patients were tested via nasopharyngeal swab polymerase chain reaction (PCR) or respiratory viral culture.

The researchers retrospectively collected data from patients' electronic medical records, including demographics, underlying medical conditions, and use of immunosuppressive agents prior to ICU admission; additionally, all respiratory culture data—including sputum, endotrachial, and bronchial specimens—and bacterial and fungal pathogens were recorded.

In addition to the case-control study, Dr Crum-Cianflone and colleagues conducted a systematic review of PubMed to identify cases of confirmed influenza with aspergillosis complications. The researchers wrote that “cases in the literature were combined with the current cases to provide a detailed summary of patients with invasive Aspergillus in the setting of influenza.”

In the  case-control study, 48 ICU patients underwent influenza testing; 8 of those patients were diagnosed with influenza infection. Of those patients, 6  had Aspergillus. The remaining 40 patients negative for influenza showed no sign of the invasive illness on any of the respiratory cultures.

Five of the patients with Aspergillus were classified as having invasive disease; 2 patients presented with influenza A (H1N1) and 3 presented with influenza B; all patients received antivirals.

“There were an increasing number of cases published in the literature over time,” Dr Crum-Cianflone and colleagues noted. “The first cases were described in 1979, followed by 3 cases in the 1980s, 2 cases in the 1990s, 2 cases in the 2000s, and 48 cases from 2010 to the first quarter of 2016, demonstrating an increasing trend of aspergillosis superinfection (P<.001).”

The researchers said their findings suggest "influenza may represent a novel host risk factor for this invasive fungal infection.” 

Reference

1.  Crum-Cianflone NF. Invasive aspergillosis association with severe influenza infections. Open Forum Infect Dis. 2016; doi: 10.1093/ofid/ofw171.

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